Risk Assessment and Management of the Mother with Cardiovascular Disease.

Chronic medical conditions account for most nonobstetrical pregnancy-related maternal complications. Preconception counseling of women with cardiovascular disease can be aided by an understanding of cardiovascular physiology in pregnancy and risk scores to guide management.

Tissue Doppler Imaging-derived Diastolic Function Assessment in Children With Sickle Cell Disease and Its Relation With Ferritin.

Diastolic dysfunction has been shown to occur earlier than systolic dysfunction in iron overload states in adult patients with sickle cell disease (SCD). Tissue Doppler imaging (TDI)-derived E/E' has emerged as a noninvasive marker of diastolic function. We sought to determine diastolic function in children with SCD and study its relation with iron overload. A retrospective review of medical records of 225 pediatric patients with SCD who received an echocardiogram between January 2008 and December 2012 was performed. Echocardiographic measures including M-mode, spectral Doppler, and TDI-derived E/E' were compared with previously published data in healthy children. The left ventricular end-diastolic and end-systolic dimensions were significantly higher in SCD (P<0.0001) and the shortening fraction was similar (P=0.66). E/E' ratio was significantly higher in SCD at the mitral annulus, septum, and tricuspid annulus. In 54% of subjects, the septal E/E' was >8, indicating elevated left ventricular filling pressure. However, there was no significant correlation between ferritin level and E/E' ratios. Pediatric patients with SCD have a high prevalence of elevated estimated left ventricular filling pressure, but this does not correlate with ferritin levels.

Electrocardiographic screening in children with attention-deficit hyperactivity disorder.

Some investigators have suggested that children receiving stimulant medications to manage attention-deficit hyperactivity disorder should undergo screening electrocardiography to identify asymptomatic cardiac disease. However, no study to date has examined the efficacy and costs of this strategy. In the present study we sought to determine the utility of electrocardiographic screening in children with attention-deficit hyperactivity disorder. We reviewed the clinical experience of electrocardiographic screening of subjects with attention-deficit hyperactivity disorder <21 years of age from April to September 2008. Additional cardiac care and testing that resulted from an abnormal initial electrocardiogram were recorded. Screening electrocardiograms were obtained in 1,470 children with attention-deficit hyperactivity disorder and were interpreted as abnormal in 119 subjects (8.1%). Further evaluation of these 119 subjects included 63 transthoracic echocardiograms, 5 stress tests, and 9 Holter monitor studies. Cardiac disease was identified in 5 subjects (0.3% of entire cohort), yielding a positive predictive value of 4.2%. Cardiac diagnoses included ventricular pre-excitation syndrome (n = 2), bicuspid aortic valve (n = 2), and moderate secundum atrial septal defect (n = 1). The mean cost of electrocardiographic screening including further testing for subjects with abnormal initial screen results was $58 per child. The mean cost to identify a true-positive result was $17,162. In conclusion, electrocardiographic screening for children with attention-deficit hyperactivity disorder can successfully identify cardiac disease in otherwise asymptomatic subjects, although the positive predictive value is low. Ongoing studies are needed to know what role electrocardiographic screening should play in the management of children with attention-deficit hyperactivity disorder.